9

of
Republic of the Philippines
Department of Health
OFFICE OF THE SECRETARY

OF
May 25, 2021

DEPARTMENT MEMORANDUM
No. 2021- 0285

the
FOR : ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES;
DIRECTORS OF BUREAUS AND CENTERS FOR HEALTH

Use
the
AUTONOMOUS REGION IN MUSLIM MINDANAO;
EXECUTIVE DIRECTORS OF SPECIALTY HOSPITALS;

ALL
Case
CHIEFS OF MEDICAL CENTERS, HOSPITALS, SANITARIA

CORPORATION;

Form
AND INSTITUTES: PRESIDENT OF THE PHILIPPINE

PORTIN NITS: ALL LOCAL Y ENT UNITS:

ALL, HOSPITAL FACILITIES; ALL LICENSED COVID-19
TESTING LABORATORIES; AND OTHERS CONCERNED

HEALTH
DISEASE
COVID-19
MINISTER
SUBJECT Investigation
Implementation

Version

INSURANCE
BANGSAMORO
DEVELOPMENT;
Department Memorandum No. 2020-0512 entitled the “Revised Omnibus Interim Guidelines
on Prevention, Detection, Isolation, Treatment, and Reintegration Strategies for COVID-19”
and Department Memorandum No. 2020-0436 entitled the “Minimum Data Requirements of
COVID-19 Related Information Systems” mandated the use of the COVID-19 Case
Investigation Form (CIF) Version 7 for case investigation and testing.

Relative to this, the CIF Version 7 was revised through the Department Memorandum No.
2021-0143 entitled the “Implementation of the Use of the COVID-19 Case Investigation
Form Version 8” to ensure interoperability and served as the minimum data fields for the
COVID-19 CIF and COVID-19 information systems. The updates and revisions this latest
CIF version address the needs of the Epidemiology and Surveillance Units (ESUs), Disease
in
Reporting Units (DRUs), such as health facilities, local government units (LGUs), and
laboratories. The revisions are as follows:

1. The addition of the following mandatory information:

a. Passport Number under number 1.5 Special Population, for Returning
Overseas Filipino (ROF) and Foreign National (FN)
b. Separate facility name and facility location for healthcare workers
under number 1.5 Special Population
c. Vaccination Information under Section 2.5
i. Date of vaccination
ii. Name of Vaccine
iii. Dose (1% and 2™)
iv. Vaccination center/facility
v. Region of health facility
vi. Adverse events (Y/N)
d. Brand kit for antigen test under number 2.7 Laboratory Information
Type of Test

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Trunk Line 8651-7800 Direct Line: 8711-9501
Fax: 8743-1829; 8743-1786 URL: http://www.doh.gov.ph; e-mail: fidugue@doh.gov.ph
 2. Changing the following field from non-mandatory to mandatory:
a. Type of Client
b. Testing Category or Subgroup
3. The removal of Indigenous Person on 1.5 Special Population

Furthermore, the accompanying amended Case Investigation Form Version 9 will be utilized
as the standard form for COVID-19 notifiable disease reporting. The CIF Version 9 comes in
two file formats: a printable form (See Annex A) and an electronic version which can be
accessed through https://tinyurl.com/cifversion9. The format of choice shall be decided
upon by the DRUs based on their capacity and means for
filling up the CIF.

All laboratories, LGUs, and other disease reporting units with an existing system for
generation of electronic CIFs shall comply with the revisions stated in this amendment.

All other provisions of DM No. 2020-0512 dated November 26, 2020 and DM No.
2020-0436 dated October 1, 2020 shall remain in effect.

For strict and immediate compliance and dissemination to all concerned.

FRANCISCO UQUE 111, MD, MSc

Segfetary of Health
 Philippine Integrated
Case Investigation Form
Disease Surveillance Coronavirus Disease (COVID-19)
and Response
Version 9
1) The Case Investigation Form (CIF) is meant to be administered as an interview by a health care worker or any personnel of the DRU. This is not a self-administered questionnaire.
2) Please be advised that DRUs are only allowed to obtain 1 copy of accomplished CIF from a patient.
3) Please fill out all blanks and put a check mark on the appropriate box. Never leave an item blank (write N/A). Items with * are required fields. All dates must be in MM/DD/YYYY format.

Disease Reporting Unit* DRU Region and Province PhilHealth

No.*
Name of Interviewer Contact Number of Interviewer Date of Interview (MM/DD/YYYY}*

Name of Informant (if applicable) Relationship Contact Number of Informant

Ifexisting case
(check all that apply}* O
OO
_
O
Not applicable (New case) O Update case classification 0 Update disposition
O
Not applicable (Unknown) O Update vaccination BO Update exposure / travel history
Update symptoms O Update lab result QO
Others, specify:
Update health status / outcome 0 Update chest imaging findings

|
Type of Client* 0O covID-19 Case (Suspect, Probable, or Confirmed) [O Close Contact 0 For RT-PCR Testing (Not a Case of Close Contact)

Testing Category/Subgroup* (Check all that apply, referto Appendix 2) [ Oa Os ac Oo Oe Or ae OR oo ao

Part 1. Patient Information
1.1. Patient Profile ~

Last Name* First Name (and Suffix)* Middle Name*

Birthday (MM/DD/YYYY)* Age* Sex* 0 Male 0 Female

Civil Status Nationality*
Occupation Works in a closed setting? 3 Yes 0 No 0 Unknown
1.2. Current Address in the Philippines and Contact Information* (Provide address of institution if patient lives in closed settings, see 1.5)
House No./Lot/Bldg.* Street/Purok/Sitio* Barangay* Municipality/City*

Province* Home Phone No. (& Area Code) Cellphone No.* Email Address

]
1.3. Permanent Address and Contact Information (if different from current address) Co
House No./Lot/Bldg. Street/Purok/Sitio Barangay Municipality/City

Province Home Phone No. (& Area Code) Cellphone No. Email Address

1.4.
Lot/Bldg.
Current Workplace Address and Contact Information
Street Barangay Municipality/City
CS
Province Name of Workplace Phone No./Cellphone No. Email Address

1.5. Special Population (indicate further

Health Care Worker* 0
details on

Yes, name of health facility:

exposure and travel history in Part 3)
and location: O
.

No
Co
OO Yes, country of origin: and Passport number: O No
Returning
eturning Filioing®
O Overseas Filipino
OFW: 0 orw 0 NomOFW

Foreign National Traveler* O Yes, country of origin: and Passport number: O No

Locally Stranded Individual / 0 Yes, City, Municipality, & Province of origin O No

/
APOR Local Traveler* O Locally Stranded Individual O Authorized Person Outside Residence / Local Traveler

Lives in Closed Settings*

0 Yes,
institution type: and name: OO No
(e.g. prisons, residential facilities, retirement communities, care homes, camps, etc.)
:

Part 2. Case Investigation Details

2.1. Consultation Information ] i
Have previous COVID-19 related consultation? 3 Yes, Date of First Consult (MM/DD/YYYY)* O No
Name of facility where first consult was done
[

2.2. Disposition at Time of Report* (Provide name of hospital/isolation/quarantine facility)

oo To
j
0 Admitted in hospital Date and Time admitted in hospital
0 Admitted in isolation/quarantine facility Date and Time isolated/quarantined in facility
0 In home isolation/quarantine Date and Time isolated/quarantined at home
O Discharged to home If discharged: Date of Discharge (MM/DD/YYYY)* O Others:
2.3. Health Status at Consult* (Refer to Appendix 3) (0 Asymptomatic [1 Mild Cl Moderate O Severe O Critical
2.4. Case Classification* (Refer to Appendix 1) O Suspect O Probable O Confirmed O Non-COVID-19 Case
2.5. Vaccination information*
Date of vaccination* Name of Vaccine* Dose number (e.g. 1%, 2n)* Vaccination center/facility Region of health facility Adverse event/s?
0 Yes 0 No

O Yes 0 No
[
2.6. Clinical Information

Date of Onset of iliness (MM/DD/YY) *

Comorbidities {Check all that apply if present)
Signs and Symptoms (Check all that apply)
[J Asymptomatic O Dyspnea 0 None O Gastrointestinal
03 Fever °C O Anorexia [J Hypertension O Genito-urinary
0 Cough 0 Nausea 0 Diabetes O Neurological Disease
[0 General weakness OO
Vomiting 0 Heart Disease 0 Cancer
0 Fatigue O Diarrhea 0 Lung Disease J Others

5
DO
Headache O Altered Mental Status O Yes, LMP O No
Pregnant? (MM/DD/YYYY)
0 0
OO
Myalgia
Sore throat O
Anosmia (loss of smell, w/o any identified cause)
Ageusia (loss of taste, w/o any identified cause) —
High-risk pregnancy? Yes ST °
[J Coryza 0 Others, specify Was diagnosed to have Severe Acute Respiratory Illness? O Yes a No

Chest imaging findings suggestive of COVID-19

Date done Chest imaging done Results
[0 Chest radiography 0 Normal [OO
Chest radiography: Hazy opacities, often rounded in morphology, with peripheral and lower lung dist.
O ChestCT 0 Pending [J Chest CT: Multiple bilateral ground glass opacities, often rounded in morphology, w/ peripheral & lower lung dist.
OO
Lung ultrasound 0 Lung ultrasound: Thickened pleural lines, B lines, consolidative patterns with or without air bronchograms

Co
0 None O Other findings, specify
2.7. Laboratory Information oo
Have tested positive using O Yes, date of specimen Collection
(MM/DD/YYYY)* 0 No
RT-PCR before? *
Laboratory* No. of previous RT-PCR swabs done
Date collected* Date released Laboratory* Type of test* Results*
0 RT-PCR (OPS) O Antigen; reason O Pending [OO
Negative
O RT-PCR(NPS) brand of kit OO
Positive [J Equivocal
O RT-PCR{OPSand NPS) [J Antibody Test 0 Others:
O Others:
0 RT-PCR (OPS) OO
Antigen; reason O Pending [OO
Negative
O RT-PCR(NPS) brand of kit 0O Positive [J Equivocal

So
O RT-PCR{OPSand NPS) OO
Antibody Test O Others:
O Others:
|
2.8. Outcome/Condition at Time of Report* ]

O Active (currently admitted/isolation/quarantine} [J Recovered, date of recovery (Mm/po/YYYY)* 0 Died, date of death (Mm/DD/YYYY)*

Ifdied Immediate Cause: Antecedent Cause:

cause of death* Underlying Cause: Contributory Conditions:

of signs and symptoms? OR

a Yes, date of last contact (MM/DD/YYYY)*
If Asymptomatic, 14 days before swabbing or specimen collection? *
O No O unknown
Has the patient been
in a place with a known COVID-19 transmission 14 days before the onset of
J Yes, International O Yes, Local
signs and symptoms? OR If Asymptomatic, 14 days before swabbing or specimen collection? * 0 No 00 Unknown exposure
IfInternational Travel, Inclusive travel dates: From: To:
country of origin With ongoing COVID-19 community transmission? O Yes O No
Airline/Sea vessel Flight/Vessel Number Date of departure (MM/DD/YYYY) Date of arrival in PH (MM/DD/YYYY)

If Local Travel, specify travel places (Check all that apply, provide name
of facility, address,Address
and inclusive travel dates in MM/DD/YYYY)
Inclusive Travel Dates With ongoing COVID-19
Place Visited Name of Place (Region, Province, Municipality/City) From: To: Community Transmission?
OO
Health Facility O Yes 0 No

0 Closed Settings a Yes

I No
O School 0 ves O No
O workplace 0 Yes O No

0 Market 0 Yes O No
[0 Social Gathering 0 Yes O No
O Others O Yes O No
O Transport Service, specify the following:
Airline / Sea vessel / Bus line / Train Flight / Vessel / Bus No. Place of Origin Departure Date (MM/DD/YYYY) Destination Date of Arrival (MM/DD/YYYY)

Name (Use the back page if needed) Contact Number

- If symptomatic, provide names and contact numbers persons who of
|
were with the patient two days prior to onset of iliness until this date
- If asymptomatic, provide names and contact numbers of persons who
were with the patient on the day specimen was submitted for testing
until this date

2
Appendix 1. COVID-19 Case Definitions
SUSPECT
A} A person who meets the
clinical AND epldemlological criteria
— Clinical criteria:
1) Acute onset of fever AND cough OR
2) Acute onset of ANY THREE OR MORE of the following signs or symptoms;
fever, cough, general weakness/fatigue, headache, myalgia, sore throat,
coryza, dyspnea, anorexia / nausea/ vomiting, diarrhea, altered mental
status. AND
— Epidemiological criteria
1) Residing/working in an area with high risk of transmission of the virus {e.g
closed residential settings and humanitarian settings, such as camp and
camp-like setting for displaced persons), any time w/in the 14 days prior to
symptoms onset OR
2) Residing in or travel to an area with community transmission anytime w/in
the 14 days prior to symptoms onset; OR
3} Working in health setting, including w/in the health facilities and w/in
households, anytime w/in the 14 days prior to symptom onset; OR
B} A patient with severe acute respiratory illness (SARI: acute respiratory infection
with history of fever or measured fever of 2 38°C; cough with onset w/in the last
10 days; and who requires hospitalization)
Appendix 2. Testing Category / Subgroup
A individuals with severe/critical symptoms and relevant history of travel/contact
symptoms, relevant history of travel/contact, and considered vulnerable;
Individuals with mild
8
vulnerable populations include those elderly and with preexisting medical conditions that
predispose them to severe presentation and complications of COVID-19
C Individuals with mild symptoms, and relevant history of travel and/or contact
Individuals with no symptoms but with relevant history of travel and/or contact or high
D exposure. These include:
D1 ~ Contact-traced individuals
- Healthcare workers, who shalt be prioritized for regular testing in order to ensure the stability
D2
of our healthcare system
D3 - Returning Overseas Filipino (ROF) workers, who shalt immediately be tested at port of entry
- Filipino citizens in a specific locality within the Philippines who have expressed intention to
04 return to their place of residence/home origin {Locally Stranded Individuals) may be tested
subject to the existing protocols of the ATF
€ Frontliners indirectly involved In health care provision in the response against COVID-19 may be
teste d as follows:
£1
Those with high or direct exposure to COVID-19 regardless of location may be tested up to once
a week. These include: {1) Personnel manning the Temporary Treatment and Quarantine
Facilities {LGU and Nationally-managed); (2) Personne! serving at the COVID-19 swabbing center;
(3) Contact tracing personnel; and {4} Any personnel conducting swabbing for COVID-19 testing
gz
Those who do not have high or direct exposure
to
COVID-19 but who live or work in Special
Concern Areas may be tested up to every two to four weeks. These include the following: {1)
Personnel manning Quarantine Control Points, including those from Armed Forces of the
Philippines, Bureau of Fire Protection; (2) National /
Regional / Local Risk Reduction and
Management Teams; (3) Officials from any local government / city / municipality health
office (CEDSU, CESU, etc.); (4) Barangay Health Emergency Response Teams and barangay
officials providing barangay border control and performing COVID-19-related tasks; {5) Personnel
of Bureau of Corrections and Bureau of Jail Penology & Management; {6} Personnel manning the
One-Stop-Shop in the Management of ROFs; {7) Border control or patrol officers, such as
immigration officers and the Philippine Coast Guard; and (8) Social workers providing
amelioration and relief assistance to communities and performing COVID-19-related tasks
Other vulnerable patients and those living in confined spaces. These include but are not limited
F to: (1) Pregnant patients who shall be tested during the peripartum period; (2) Dialysis patients;
(3) Patients who are immunocompromised, such as those who have HIV/AIDS, inherited diseases
that affect the immune system; (4) Patients undergoing chemotherapy or radiotherapy; (5)
Patients who will undergo elective surgical procedures with high risk for transmission; (6) Any
person who have had organ transplants, or have had bone marrow or stem cell transplant in the
past 6 months; (7) Any person who is about to be admitted in enclosed institutions such as
Jails, penitentiaries, and mental institutions.
Appendix 3. Severity of the Disease
MILD
Symptomatic patients presenting with fever, cough, fatigue, anorexia, myalgias;
other non-specific symptoms such as sore throat, nasal congestion, headache,
dia rrhea, nausea and vomiting; loss of smell (anosmia) or loss of taste (ageusia)
preceding the onset of respiratory symptoms with NO signs of pneumonia or
hypoxia
MODERATE
1 Adolescent or adult with clinical signs of non-severe pneumonia (e.g. fever,
cough, dyspnea, respiratory rate (RR) = 21-30 breaths/minute, peripheral
capillary oxygen saturation (Sp0O2) 92% on room air}
. Childwith clinical signs of non-severe pneumonia {cough or difficulty of
breathing and fast breathing [ < 2 months: > 60; 2-11 months: > 50; 1-5 years: > lactate or hyperbilirubinemia
40) and/or chest indrawing)
SEVERE
. Adolescent or adult with clinical signs of severe pneumonia or severe acute
respiratory Infection as follows: fever, cough, dyspnea, RR>30 breaths/minute,
severe respiratory distress or Sp0O2 < 92% on room air
. Child with clinical signs of pneumonia (cough or difficulty in breathing) plus at
least one of the following:
a. Central cyanosis or SpO2 < 90%; severe respiratory distress (e.g. fast
breathing, grunting, very severe chest indrawing); general danger sign:
inability to breastfeed or drink, lethargy or unconsciousness, or convulsions.
b. Fast breathing {in breaths/min}: < 2 months: > 60; 2-11 months: > 50; 1-5
years: > 40.
PROBABLE
A) A patient who meets the clinical criterla the left) AND is contact of a probable or confirmed case,
(on
or epldemiologically linked to a cluster of cases which had had at least one confirmed identified within
that cluster
B) A suspect case (on the left) with chest Imaging showing findings suggestive of COVID-19 disease.
Typical chest imaging findings include (Manna, 2020):
Chest radiography: hazy opacities, often rounded in morphology, with peripheral and lower lung
distribution
Chest CT: multiple bilateral ground glass opacities, often rounded in morphology, with peripheral
and lower lung distribution
Lung ultrasound: thickened pleural lines, B lines (multifocal, discrete, or confluent), consolidative
patterns with or without air bronchograms
C) A person with recent onset of anosmia (loss of smell), ageusia (loss of taste) in the absence of any
other identified cause
D) Death, not otherwise explained, in an adult with respiratory distress preceding death AND who was a
contact of a probable or confirmed case or epidemiological linked to a cluster which has had at least
one confirmed case identified with that cluster
CONFIRMED
A person with laboratory confirmation of COVID-19 infection,
irrespective of clinical signs and symptoms.
6 Residents, occupants or workers in a localized area with an active COVID-19 cluster, as identified
and declared by the local chief executive in accordance with existing DOH Guidelines and
consistent with the National Task Force Memorandum Circular No. 02 5.2020 or the Operational
Guidelines on the Application of the Zoning Containment Strategy in the Localization of the
National Action Plan Against COVID-19 Response. The local chief executive shall conduct the
necessary testing in order to protect the broader community and critical economic activities and
risk of to avoid a declaration of a wider community quarantine.
—
H Frontliners in Tourist Zones:
All workers and employees in the hospitality and tourism sectors in El Nido, Boracay, Coron,
H1
Panglao, Siargao and other tourist zones, as identified and declared by the Department of
Tourism, These workers and employees may be tested once every four (4) weeks.
H2 All travelers, whether of domestic or foreign origin, may be tested at least once,
at their own
expense, prior to entry into any designated tourist zone, as identified and declared by the
Department of Tourism.
| workers and employees of manufacturing compantes and public service providers registered
All
In economic zones located in Special Concern Areas may be tested regularly.
3 Economy Y Workers
n Frontline and Economic Priority Workers, defined as those 1) who work in high priority sectors,
"
both public and private, 2) have high interaction with and exposure to the public, and 3) who live
or work in
Special Concerns Areas, may be tested every three (3) months. These include but not
limited to:
- Transport and Logistics: drivers of taxis, ride hailing services, buses, public transport vehicle,
conductors, pilots, flight attendants, flight engineers, rail operators, mechanics, servicemen,
-
delivery staff, water transport workers (ferries, inter-island shipping, ports}
Food Retails: waiters, waitress, bar attendants, baristas, chefs, cooks, restaurant managers
- Education: teachers at
all levels of education and other school frontliners such as guidance
counselors, librarians, cashiers
- Financial Services: bank tellers
- Non-Food Retalls: cashiers, stock clerks, retail salespersons
- hairdressers, barbers, manicurists, pedicurists, massage therapists, embalmers,
Services:
undertakers, funeral directors, parking lot attendants, security guards, messengers
morticians,
- Construction: construction workers including carpenters, stonemasons, electricians, painters,
foremen, supervisors, civil engineers, structural engineers, construction managers, crane/tower
operators, elevator installers, repairmen
- Water Supply, Sewerage, Waster Management: plumbers, recycling/ reclamation workers,
garbage collectors, water/wastewater engineers, janitors, cleaners
- Public Sector: judges, courtroom clerks, staff and security, all national and local government
employees rendering frontline services in special concern areas
- Mass Media: field reporters, photographers, cameramen
All employees not covered above are not required to undergo testing but are encouraged to be
12 tested every quarter. Private sector employers are highly encouraged to send their employees
for regular testing at the employers’ expense
in order to avoid lockdowns that may do more damage to their companies.
CRITICAL
Patients manifesting with acute respiratory distress syndrome, sepsis and/or septic shock:
1. Acute Respiratory Distress Syndrome (ARDS)
a. Patients with onset within 1 week of known clinical insult (pneumonia) or new or worsening respiratory
symptoms, progressing infiltrates on chest X-ray or chest CT scan, with respiratory failure not fully
d by cardiac failure or fluid overload
2. Sepsis
a. Adults with life-threatening organ dysfunction caused by a dysregulated host response to suspected or
proven infection. Signs of organ dysfunction include altered mental status, difficult or fast breathing,
low oxygen saturation, reduced urine output, fast heart rate, weak pulse, cold extremities or low blood
pressure, skin mottling, or laboratory evidence of coagulopathy, thrombocytopenia, acidosis, high
b. Children with suspected or proven infection and > 2 age-based systemic inflammatory response
syndrome criteria (abnormal temperature [> 38.5 *C or < 36 °C); tachycardia for age or bradycardia for
age if < lyear; tachypnea for age or need for mechanical ventilation; abnormal white blood cell count
for age or > 10% bands), of which one must be abnormal temperature or white blood cell count.
3. Septic Shock
a. Adults with persistent hypotension despite volume resuscitation, requiring vasopressors to maintain
MAP > 65 mmHg and serum lactate level >2mmol/L
b. Children with any hypotension (SBP < Sth centile or > 2 SD below normal for age) or two or three of the
following: altered mental status; bradycardia or tachycardia (HR < 90 bpm or > 160 bpm in infants and
heart rate < 70 bpm or > 150 bpm in children); prolonged capillary refill (> 2 sec) or weak pulse; fast
breathing; mottled or cool skin or petechial or purpuric rash; high lactate; reduced urine output;
hyperthermia or hypothermia.